Opinion

Proposed guidelines on alternative medicine must be enforced to stem the tide of misinformation

The College of Physicians and Surgeons of Ontario’s (CPSO) draft of a policy guiding doctors’ use of alternative medicines does not go far enough in protecting patients.

The CPSO, the self-governing body that regulates the practices of medical doctors, is developing policies on what types of alternative medicines (CAM) MDs can prescribe and how they should discuss them with their patients. However, the policy does not include enforcement standards, raising the question of how effective it will be in the face of mounting pressure from alt-health groups.

The current version of the CPSO’s CAM policy was written in 1997, at a time when health misinformation had a much different (and less powerful) role in our society. Since then, social media has taken on a new role. We are saturated with information, both accurate and inaccurate, making people more vulnerable to anti-vaccine rhetoric and conspiracy theories at a time when we desperately need public support for science.

Physicians are not immune to health misinformation, nor to the financial temptations of offering phony “alternative” treatments for a fee. Over the past two decades, alternative health companies have created more and more products and thus more opportunities for physicians to earn money by promoting them. This can lead to conflicts of interest in which doctors prescribe products that are not needed because it creates revenue for them. Doctors can also profit from the referral fees for sending patients to alternative health clinics. These practices compromise public confidence in our health institutions.

Within this context, it’s an important step for the CPSO to draft a new, more rigorous CAM policy. The College has now undertaken two years of public consultations, surveying health providers and the public, and it will release a new guide later this year.

I’ve seen a draft of the new policy. It’s stronger than the 1997 version (and its 2000/2011 updates). The revised policy now clearly emphasizes physicians’ responsibility to avoid conflicts of interest and scams. The overall wording of the document is more forceful as well. As the CPSO notes in its survey, it has evolved from using “informed by evidence” as a standard of care to “supported by evidence and scientific reasoning.” It has also replaced the concept of “advised” conduct with the phrase “Physicians must, which appears in bold letters throughout the new document. For example:

  • “Physicians must not provide complementary or alternative treatments that have been proven ineffective.” 
  • “Physicians (prescribing CAM) must specifically document the risk-benefit analysis undertaken to determine its appropriateness.”

The new version makes it easier to gather evidence in complaints about a physician because it mandates better record-keeping by physicians prescribing CAM. Its conflicts of interest section is also stronger, outlining consequences for physicians who make money selling phony products or who profit from bogus referrals to alternative care clinics. It includes the directive that physicians “must not associate themselves with any advertising for a commercial product or service other than their own medical services … and must ensure any published materials relating to a professional affiliation are accurate, factual, and based on evidence and scientific reasoning.”

In response to these changes, CAM providers are pressuring the College to revise the draft to be more friendly to their business interests. Their group, Ontario Patients for Integrative Medicine (OPIM), advises followers to write to the College and visit its public consultation portal, stating: “Our access to integrative medicine is at risk. Patients will suffer!”

When I contacted OPIM to ask if people from outside of Ontario could contribute to this provincial consultation, I received a reply stating that a person from out of province “can most definitely write letters, complete the survey and submit a response on the College’s consultation page if you are not from Ontario.” OPIM supporters have flooded the CPSO’s online consultation portal with claims that patient rights could be taken away by the new guidelines. But the College is not stopping the manufacture or sale of CAM products, nor is it preventing people from using them. The proposed new policy only directs physicians to avoid conflicts of interest, to keep proper records and to not mislead patients about unproven products.

The OPIM doesn’t acknowledge that some forms of CAM exploit patients, nor that some products put patient safety at risk. Instead, it has framed the issue as “CAM under attack.” But in this era of health misinformation, it’s almost comical to conceive of CAM being under attack because CAM is everywhere– from the pharmacy aisles and convenience stores to palliative care clinics and our social media feeds. Meanwhile, anti-mask rallies and the Plandemic movement compromise our ability to manage COVID-19 and bring the pandemic to an end. These projects paint a grim picture of the broader CAM community as an enabler of dangerous health misinformation. 

As an advocate against exploitative forms of CAM, my concerns are different than OPIM’s. In my view, the CPSO’s proposed new policy is not strong enough. I fear that the document could have little more than a symbolic meaning if the College doesn’t also take action to ensure that its policies are enforced. Under the draft, the CPSO is not mandated to meaningfully investigate complaints about physicians involved in pseudoscience. Without enforcement, the new policy may be little more than words on paper.

In fact, that is how the old policy sometimes played out. In 2018, I wrote a complaint to the College about an MD who was promoting anti-vaccine ideology while treating autistic children with an expensive, off-label drug (chelation) that has no evidence of benefit and clear evidence of harm, including deaths. The procedure violates both U.S. and U.K. law as well as the College’s own CAM policy. Yet the CPSO claimed that it was not required to pursue the complaint and dismissed it without even reviewing the evidence I’d submitted. Three years later I am still asking myself: Why?

Now, reading the College’s proposed policy, I see once again a glaring omission: enforcement. And I wonder why the College doesn’t include it. After all, a policy – no matter how strongly worded – is only as powerful as the CPSO’s will to enforce it.

7 Comments
  • Scott Simpson says:

    As someone who has been medically harmed by ‘conventional’ medicine that has embedded medical error as a standard of care for people living with myalgic encephalomyelitis (ME), the ONLY safe and appropriate care I have received is from integrative doctors.

    As a result of my experience with medical harm, I started a podcast (Medical Error Interviews) and none of my 88 guests and counting were harmed by integrative medicine. All were harmed (or family member killed) by ‘conventional’ medicine.

    So integrative medicine is not the problem. Nor is conventional medicine.

    With medical error still being the 3rd leading cause of death for decades, the patient safety problem is medical culture.

    Change medical culture (god complex, gaslighting, inflated egos) and it will change patient safety.

  • Dr. Rob Murray says:

    “Every once in awhile we should take our biases out and scrub them off so the light can shine through”–Alan Alda.

    You will find Steven Phillips, MD and Dana Parish, HMH 2020 have addressed this topic very well in Chronic – The Hidden Cause of the Autoimmune Disease… Science is provisional, a way of knowing. Dr. Phillips has treated over 100 physicians for Lyme+ disease and over 20,000 for complex diseases.

    Evidenced based medicine is fine except in many cases it is edited and pruned of everything that doesn’t agree with dogma. It is evidenced biased medicine. “The greater the ignorance the greater the dogma” -Osler. Randomized double blind controlled trials are great except they 1.) take too long, 2.) are too expensive and 3.) don’t apply to most people. Who gets to say what is evidence anyway?

    Historically infection has always been seen to be the root cause of inflammation. Antibiotics have been shown to improve the situation for rheumatoid arthritis and MS patients but this has been ignored. The modern paradigm of medicine is to name it and treat it. There are 4 types of MS but neurologists still don’t know the cause. We are told not to worry because they are coming out with new treatments all the time. The treatments are estimated to reach a value of $66Bn in 2025. Why would anyone want to look for a cure? How many suffer from CFS/ ME/FM or an underlying infection of bartonellosis need to have their immune system dampened?

    Why is the medical community complacently treating patients with inflammatory autoimmune disease with immunosuppressives when these drugs only treat symptoms-not root cause-and put patients a greater risk for developing potentially life-threatening opportunistic infections and cancers? To do this is contradictory to the principles of precision medicine which is based upon the notion that development of effective therapeutic interventions requires an understanding of the processes underlying the pathogenesis of the disease. How can we expect to cure autoimmune disease when we don’t know what we are treating?

    The art of medicine is gone and its medicine that has lost its way. 50 years ago everything was diagnosed clinically. Now days they have tests for just about everything and everything that they don’t have a test for gets thrown on the compost pile of psychiatric diseases. Because what they’re sick with, what they’re struggling with is absolutely valid. And if science can’t yet measure it, if our diagnostics aren’t there, that doesn’t mean it’s not happening. It means we need better diagnostics. The psychiatrist such as Dr. Robert Bransfield are left to tell the patient “of course you’re sick, you’re brain is infected.

    Botanicals have been used for over 5,000 years and seldom cause problems and don’t create antibiotic resistance. Using them in combination with antibiotics can mean using less antibiotics. Sick patients just want to get well yet they are caught in a turf war.

    e.g. Identification of Essential Oils with Strong Activity against Stationary Phase Borrelia burgdorferi, Feng J, Miklossy J, Zhang Y, et al, Antibiotics 7[4], 89; 19-10-16: 89 DOI: 10.3390/antibiotics7040089
    https://www.ncbi.nlm.nih.gov/pubmed/30332754

    Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi, Feng J, Zhang Y, et al., Front Med 20-02-21: https://doi.org/10.3389/fmed.2020.00006 https://www.frontiersin.org/articles/10.3389/fmed.2020.00006/full

    Botanical Medicines Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum, and Alchornea cordifolia Demonstrate Inhibitory Activity Against Babesia duncani, Zhan Y et al., Front Cell infect Microbiol 21-03-08: https://doi.org/10.3389/fcimb.2021.624745 | https://www.frontiersin.org/articles/10.3389/fcimb.2021.624745/full

    Obsolete inaccurate blood tests still bring in big money for the patent holders, so why would they want to improve them? Why not just control the conversation, keep saying that they work fine?

    Pharmaceutical industries sell few cures but lots of bandages – very expensive bandages that require lifelong refills. No pharmaceutical company is interested in finding the cause of autoimmune disease and eradicating it. That wouldn’t be profitable.

    This is a medical system divided against itself. Adherents to the dominant
    medical opinion on Lyme and tick-borne diseases [TBD’s] are willing for various ideological reasons to let people perish. The defining characteristic of corruption in modern medicine is the abandonment of the patient’s interest. How many Alzheimer’s, Parkinson’s and ALS patients actually have treatable diseases? Patients are often road-kill on the highway to profit for the insurance industry.

    Dr. Rob Murray [DDS ret’d], Lunenburg, NS, Canada
    Board member Canadian Lyme Disease Foundation [www.CanLyme.org]

    Reference: Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ Kim T, CNBC 18-04-11: https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html

  • K Kilburn says:

    Well sure. I know so many people who take their health information from social media, and the dangers are frequent and obvious. And this has expanded drastically during my adult lifetime (over 50 years).

    What your comment doesn’t address are the reasons this has happened, and will continue to happen. One is of course the unfiltered, uncontrolled, ubiquitous world of social media. All the news that fits, right, wrong, or otherwise.

    But the one that is most extremely dangerous, and which you have completely avoided, is the multiple failures of the medical community itself.

    “some forms of [medicine] exploit patients, nor that some products put patient safety at risk”. Yup. And that is completely and entirely and unforgivably neglected and beyond control.

    And as someone who worked 20 years for a provincial, science-based, addictions organization, I got to see this first-hand, daily.

    Start with one example: opioids. The completely unethical over-prescribing, inappropriate prescribing, failure to educate oneself, failure to educate one’s patients, failure to search for alternatives to opioids before reaching for a prescription pad. The deluge of opioid prescribing because it was faster, easier, less demanding, and hey–the pharmaceutical company reps TOLD the docs that it was fine fine fine–while early-stage professional medical journals were already raising the alarm. And of course the companies hid their own research indicating the dangers, and made billions. This was murder, by any other name. And communities were devastated. Not to mention the incredible human and financial impact to the health care system.

    And then most docs decided that addicts, most of whom they’d created, were too icky to take on as MMT patients. Despite the MMT mill which saw most physicians resist free, professional, science- and research-based training for appropriate prescribing of MMT. Unless they were wined and dined. Because it took time away from their practices, which impacted the bottom line. All the while continuing to continue to dish out scrips as above. Adding labs to their practices, at higher cost to the system, unnecessarily. Refusing to include knowledgeable, trained, and experienced addictions counsellors as the essential complement to scrips and labs. Because, as one ER head said when refusing the offer of a cost-free counsellor for Saturday night “after all, it’s their choice”. Try refusing a diabetic, or a bungee-jumper or wild country skiier on those grounds.

    One of the most obscene features of this grotesque “do no harm” value was the CPSO’s bargaining position several years ago for “wages” (by any other name) stating that if the government didn’t come through, they would stop serving MMT patients. The most stigmatized, the highest-need, the most consequential, and the entirely iatrogenic population. And along the way, the complete absences of CPSO in disciplining physicians. Ontario had a patch-for-patch program developed in my local community, jointly with police, at the grass-roots level. It was highly effective at the time–deaths plummeted, and the program spread. It became law. And then the regulations made it entirely voluntary for physicians, and pharmacists, to follow. That abortion of the policy, and the next step with the import of Chinese fentanyl, was the end of that intervention.

    That’s just one blatant and fatal failure.

    The sole practitioner has practically vanished, because corporations are, well, you know how much more lucrative those are.

    The revelations of the corruption of some medical and scientific research is another. “Peer review” means jack, in many cases.

    The abject failure of CPSO to monitor, evaluate, discipline its members makes your suggestion of adding alternative meds to their realm beyond laughable–it’s idiotic, and self-serving.

    The government’s failure to monitor, evaluate, and discipline physicians for anything other than adherence to financial requirements is a betrayal of the citizenry. Physicians, “do no harm”, are the most critical, and most entirely free profession, from any ordinary employment situation. They choose their field of education and training without any required consideration of need for family practitioners versus higher-status and more lucrative specialties. They choose their practice location, again without any adherence to health planning needs for populations and locations. They refuse to offer necessary and legal services that offend their own personal value systems. And because this myth that they are “small business people” continues, they’re scot-free to do so. Catch a corner store operator getting away with this … stuff.

    Do you think the population is ignorant of any or all of this? Sadly, I am continually gob-smacked by patients’ blind acceptance and loyalty to this sort of physician behaviour. The cult of the physician as demi-god is now well-established. IMO, they ought never to have left the barbershop, in many cases.

    Of course there are ethical, moral, professional, competent physicians out there. But it’s a crap-shoot, and there are no external controls.

    And the CPSO, among others, does, ummmmmm, what about this? It’s free-range practice out there.

    Of course alternative medicine requires controls, like all of the above points. But the traditional medical field had better clean up its own act first.

  • Esther Konigsberg says:

    Dear Ms. King,
    I sympathize with your concern of misinformation on the internet that drives many people away from public health measures that are so crucial during this pandemic. Any health professionals who feed into unfounded conspiracy theories, should be soundly admonished, especially medical doctors. I also read with concern your account of certain CAM treatments for autistic children. I cannot comment about your specific case, as I do not have sufficient information to do so.

    I do take issue with characterizing all physicians who practice CAM or Integrative Medicine as charlatans. To paint a group with such a wide stroke, is grossly unfair. As you may be aware, Integrative Medicine is considered a discipline in the U.S. Integrative Medicine can be defined as healing oriented medicine which takes into account the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. Many academic institutions have educational, research and clinical initiatives in this area including Harvard, Yale, Stanford, and the Mayo Clinic. 70 of these institutions including 5 Canadian Medical Schools have formed the Academic Consortium for Integrative Medicine and Health to advance the field of Integrative Medicine. There are roughly 20 Integrative Medicine Fellowships.These Integrative Medicine fellowships are run by such institutions as the University of Michigan, Northwestern University, UCSF (University of California, San Francisco) ,UCLA and others and are equal in calibre to any other fellowships at these institutions. Integrative Medicine is now board certifiable under the American Board of Physician Specialties and many Canadian Physicians are board certified.

    There has been an unprecedented explosion of research in this area where the National Institute of Health and Canadian Institute of Health have invested more than $1.3B in research funding over the past decade alone. Recently the Veteran’s Affairs published data from 18 pilot sites that have integrated these modalities into their system and demonstrated improved health outcomes, cost effectiveness and improved patient and employee satisfaction.

    Your comments above does nothing to acknowledge the advancement of Complementary and Integrative Medicine. Many patients have turned to Integrative Medicine Physicians, including those patients who have been misinformed. The vast majority of us do our best to encourage them to use lifesaving conventional therapies, including vaccines, and they are more likely to listen to us than our fully conventional colleagues. We have other tools to support our patients in finding the best of both worlds in their pursuit of quality of life.

    As in all professions, there are a spectrum of physicians, both Conventional and Integrative. The College already has policies in place meant to protect patients which lays out our professional ethics, including avoiding conflict of interest and exploitation of our patients. Unfortunately, the new proposed CAM policy is overly harsh and wide sweeping and will discourage all physician from practicing Complementary and Integrative Medicine. And yes, as the ONPIM site states, this will deprive our patients from finding physician experts in this field. This will drive our patients towards less qualified practitioners, or outside of Ontario to find care.

    Please reconsider demonizing a whole discipline based on a few bad experiences. I am happy to discuss this further.

    Dr. Esther Konigsberg M.D. CCFP
    Assistant Clinical Professor McMaster University
    Assistant Clinical Professor University of Arizona
    Institutional Representative Academic Consortium of Integrative Medicine and Health
    Chair of the Fellowship Recognition Committee for the American Board of Integrative Medicine
    Upcoming Chair of the Ontario Medical Association Complementary and Integrative Medical Interest Group

  • Adrienne says:

    For a website claiming to be called “healthy debate”, I find this article extremely biased and one-sided. Physicians practicing complementary and integrative medicine are highly educated with fellowships at accredited medical schools and often board certified in integrative medicine. You say that:
    -> Physicians are not immune to health misinformation and you also imply that CAM physicans practice psuedoscience. I can assure you that our rationale for recommending our therapies comes from reviewing medical evidence in research databases and textbooks, not from reading random information on the internet with no supporting references. If you insist on practicing medicine in a way that ignores all forms of evidence other than randomized control trials, there is therefore inadequate evidence to recommend smoking cessation for any kind of health benefits, or parachutes to prevent trauma from falls, for that matter.
    -> physicians “must not associate themselves with any advertising for a commercial product or service other than their own medical services – We have advertising policies that strictly outline these practices again for ALL physicians.
    I can assure you that the vast majority of integrative physicians, like the vast majority of conventional physicians, and members of all professions, are practicing in a way that is ethical, honest, and in a way that best supports the patients or clients that are involved in that industry. Your article does nothing to speak to those physicians and presents an extremely biased view of any doctor who choses to think outside the box or use their clinical judgement in addition to guideline-based therapies.

    • Tiredofstupid says:

      Yo, this is an OPINION, not an ARTICLE. It’s supposed to be one-sided. You do not need to speak to other practitioners in an opinion editorial.

      Since I have a feeling you have no idea what an opinion is vs. an article, here you go. You’re welcome:

      o·pin·ion piece
      noun
      an article in which the writer expresses their personal opinion, typically one which is controversial or provocative, about a particular issue or item of news.
      “an opinion piece in the Wall Street Journal predicted the closing of practices to new patients”

      You write: “Your article does nothing to speak to those physicians and presents an extremely biased view of any doctor who choses to think outside the box or use their clinical judgement in addition to guideline-based therapies.” — this is NOT an article. You take issue with this? Write your own piece and integrate your own opinions and I’m sure they will run it. But don’t ask someone writing an opinion editorial to become a journalist or reporter and write something unbias. That just shows you have zero understanding of media, publishing and types of content. Do you also consider a blog to be mainstream? (Jeez. The ignorance of people who don’t understand what the heck they are reading before writing a stupid comment like this.)

      And if you keep taking down websites for publishing a piece or a sentence you don’t like, you might as well just get your news from your facebook feed. They filter that out for you so you can just keep drinking whatever koolaid you want.

  • Mike Fraumeni says:

    Alternative medicine may be similar in some ways to psychological therapies whereby proponents say that the evidence-based medicine model where randomized controlled trials may not be suitable to show efficacy of treatment. This I don’t know but Dr. Mike Scott’s blog, CBT watch, may be of some relevance to the alternative medicine situation. See:
    http://www.cbtwatch.com

Authors

Anne Borden King

Deputy editor

Anne Borden King is the founder of the Campaign Against Phony Autism Cures, Canada and the host of Noncompliant, a podcast about neurodiversity.

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